title: Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?
abstract: OBJECTIVE
  The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmann's procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection.
  
  
  METHODS
  All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long-term results were noted.
  
  
  RESULTS
  From 2000-11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC. Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation (n = 6) or as palliation in a severely ill patient (n = 5). The remaining 61 (73.5%) patients had an IC, with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty-nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7-17) days. The overall median length of hospital stay was 20 days and the 30-day mortality was 3/61 (5%).
  
  
  CONCLUSIONS
  IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy.
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine, University Pierre & Marie Curie, Paris VI, France.
authors.forename: N
authors.initials: N
authors.lastname: Chéreau
authors.forename: J H
authors.initials: JH
authors.lastname: Lefevre
authors.forename: M
authors.initials: M
authors.lastname: Lefrancois
authors.forename: N
authors.initials: N
authors.lastname: Chafai
authors.forename: Y
authors.initials: Y
authors.lastname: Parc
authors.forename: E
authors.initials: E
authors.lastname: Tiret
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D044683:Colon, Descending / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
keywords: Colorectal cancer; Hartmann procedure; colostomy; obstruction